Uses
Major Depressive Disorder
Management of major depressive disorder.
Results of several studies of TCAs in preadolescent and adolescent patients with major depression indicate lack of overall efficacy in this age group.
Panic Disorder
Has been used for the management of panic disorder† with or without agoraphobia†.
Eating Disorders
Has been used for the management of eating disorders† (e.g., bulimia†, anorexia nervosa†) with equivocal results; avoid use in underweight individuals and in those exhibiting suicidal ideation.
Bipolar Disorder
Has been used for the short-term management of acute depressive episodes in bipolar disorder†.
TCAs associated with a greater risk of precipitating hypomania or manic episodes than other classes of antidepressants; should always be used in combination with a mood stabilizer (e.g., lithium).
Schizophrenia
Has been used for the management of acute depressive episodes (in combination with an antipsychotic) in patients with schizophrenia†.
Postherpetic Neuralgia
Among the drugs of choice for the symptomatic treatment of postherpetic neuralgia†.
Insomnia
Less effective for insomnia† and associated with more serious adverse reactions than conventional hypnotics.
Attention Deficit Hyperactivity Disorder (ADHD)
Not recommended for use in children with ADHD†. (See Pediatric Use under Cautions.)
Dosage and Administration
General
- Allow at least 2 weeks to elapse between discontinuance of therapy with an MAO inhibitor and initiation of desipramine and vice versa. Also allow at least 5 weeks to elapse when switching from fluoxetine.
- Monitor for possible worsening of depression, suicidality, or unusual changes in behavior, especially at the beginning of therapy or during periods of dosage adjustments. (See Worsening of Depression and Suicidality Risk under Cautions.)
- Sustained therapy may be required; administer lowest effective dosage and monitor periodically for need for continued therapy.
- Avoid abrupt discontinuance in patients receiving high dosages for prolonged periods. To avoid withdrawal reactions, taper dosage gradually.
Administration
Oral Administration
Administer in up to 3 divided doses or as a single daily dose at bedtime (to avoid daytime sedation) or in the morning (to avoid insomnia and/or stimulation from the drug).
Administer desipramine hydrochloride dosages of 300 mg daily in a hospital setting, where regular visits by the physician, skilled nursing care, and frequent ECGs are available.
Dosage
Available as desipramine hydrochloride; dosage is expessed in terms of the salt.
Pediatric Patients
Major Depressive Disorder
Oral
Adolescents ≥12 years of age: Initially, 25–50 mg daily. Increase dosage gradually until maximal therapeutic effect with minimal toxicity is achieved or up to a maximum dosage of 100 mg daily. (See Pediatric Use under Cautions.)
Usual dosage: 25–100 mg daily. Dosage may be further increased to 150 mg daily, if necessary, in more seriously ill patients.
After symptoms are controlled, gradually reduce dosage to the lowest level that will maintain relief of symptoms.
Adults
Major Depressive Disorder
Oral
Initially, 75–150 mg daily, depending on the severity of the condition being treated. Increase dosage gradually until maximal therapeutic effect with minimal toxicity is achieved.
Usual dosage: 100–200 mg daily. Dosage may be further increased to 300 mg daily, if necessary, in more seriously ill patients.
After symptoms are controlled, gradually reduce dosage to the lowest level that will maintain relief of symptoms.
Prescribing Limits
Pediatric Patients
Major Depressive Disorder
Oral
Adolescents ≥12 years of age: Maximum 150 mg daily.
Adults
Major Depressive Disorder
Oral
Maximum 300 mg daily.
Special Populations
Geriatric Patients
Initially, 25–50 mg daily. Increase dosage gradually until maximal therapeutic effect with minimal toxicity is achieved or up to a usual maximum dosage of 100 mg daily.
Usual dosage: 25–100 mg daily. Dosage may be further increased to 150 mg daily, if necessary, in more seriously ill patients.
After symptoms are controlled, gradually reduce dosage to the lowest level that will maintain relief of symptoms.
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